Joint Replacement Institute

Hip Resurfacing: Indications, Results and Prevention of Complications for Patients with Arthritis Secondary to DDH, SCFE, LCP, RA, Trauma, etc…

Published in: Treatment of Osteoarthritic Change in the Hip - Joint Preservation or Joint Replacement? Sofue, Muroto; Endo, Naoto (Eds.) Springer 2007 page 195 – 204

Invitational Lecture Presented at the Japanese Hip Society – Niigata, Japan 2005

Harlan C. Amstutz, MD

Michel J. Le Duff, MA

Frederick J. Dorey, Ph.D

The purpose of the present study was to review the indications and assess the clinical results of a current metal-on-metal hip resurfacing design in a population of patients treated for secondary osteoarthritis.

208 patients (238 hips) underwent metal-on-metal hybrid hip resurfacing with a diagnosis of non-primary osteoarthritis. The patients were young (average 41.4 years (range, 14 to 63).) and 62% were males. The degeneration of the articular cartilage was secondary to DDH in 82 hips (34.5%), ON in 70 (29.4%), PT in 35 (14.7%), LCP disease in 20 (8.4%), SCFE in 13 (5.5%), inflammatory joint disease in 15 (6.3%), pigmented villonodular synovitis in 2 (0.8%) and melorheostosis in 1 (0.4%). Forty-six hips (19.3%) had undergone a prior operation before resurfacing, including 13 osteotomies, 12 core decompressions, 14 pinning of the femoral head, 2 hemi-resurfacing, and 5 other procedures The study group presented greater anatomical deformities and risk factors (SARI score) for resurfacing than a control group of patients operated for primary osteoarthritis.

The average follow-up was 5.6 years. All clinical scores showed significant improvements post-operatively (p<0.001). Kaplan-Maier survivorship at 4 years was 95%, using any revision as end point. In comparison with primary OA patients, the study group had slightly inferior results, explained by the difference in risk factors. However, improvements in the surgical technique have demonstrated that these risk factors can be overcome as early failures pertained to the early stage of development of our surgical technique. Specific training programs for resurfacing are needed to minimize the learning curve of new surgeons undertaking this procedure for these conditions.